The 2016 rankings show that health in rural areas is suffering the most.

Many factors influence human health. It’s not just a matter of whether people have insurance and access to a doctor (though these things are obviously important). Health outcomes are also affected by employment (losing a job is generally bad for your health), education, crime rates, and air quality. And it’s only by considering these wider factors that neighborhoods become healthier, public health advocates believe.

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That’s why the annual County Health Rankings are important. They not only show health standards at a local level–they also show the multiple factors that pertain to health outcomes, everything from racial segregation and sleep patterns to smoking rates and access to decent food.

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The 2016 rankings show a growing divergence between rural and urban areas. Generally, the U.S. has seen increased life expectancy (the granddaddy of health outcome measures) over the last few decades. But rural areas are now experiencing premature death rates (that is, deaths before average life expectancy) go up. One in six Americans lives in a rural county.

The 2016 rankings show a growing divergence between rural and urban areas.

“One in five rural counties is seeing worsening premature death rates rather improvements,” says Bridget Catlin, co-director of the County Health Rankings. “There’s no one single factor we can attribute this to, but access to jobs, health care, quality education, adequate housing and lack of public transportation all come into play.”

The latest rankings reveal other interesting trends. For example, health outcomes are generally worse in areas of high residential segregation. Where African Americans and whites are more integrated, they’re health is better. Segregation–measured by the percentage of either blacks or whites in a county who would have to move census tracts to achieve racial balance–is greatest in the Northeast and the Great Lakes region.

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The rankings give detailed reports for more than 3,000 counties, showing both measures of health (like the premature death rate) and factors affecting health (like high school completion rates). The idea is that counties can look up their data and then design programs to improve what’s lacking in their area.

Catlin points to places like Spartanburg County, South Carolina, which has markedly improved its outcomes in recent years. Last year, the Robert Wood Johnson Foundation, which sponsors the rankings, awarded Spartanburg its Culture of Health Prize, recognizing its holistic health approach.

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“These places are getting all the people together from different walks of life and figuring out what needs to be done and how to get it done,” Catlin says. “I’m heartened people realize there’s more to health than health care. Six years ago, a lot of the discussion focused just on whether people had insurance. Now communities are seeing there are really critical health issues like early childhood education and high school graduation as well.”